Epidermolytic hyperkeratosis: a rare case

A 6 month old girl presented with generalized hyperkeratosis, most marked over the flexures since birth. On the basis of the clinical& histopathologic findings, she was diagnosed as a case of epidermolytic hyperkeratosis .She was treated with retinoid therapy. Epidermolytic hyperkeratosis (EHK) is an uncommon form childhood keratinizing disorder. Early in life it is associated with generalized blistering and erythroderma. Later on, it produces rippled type of hyperkeratosis. The purpose of this report is to highlight the features of this rare case

Nature of singularity formed by the gravitational collapse in Husain space-time with electromagnetic field and scalar field

In this work, we have investigated the outcome of gravitational collapse in Husain space-time in the presence of electro-magnetic and a scalar field with potential. In order to study the nature of the singularity, global behavior of radial null geodesics have been taken into account. The nature of singularities formed has been thoroughly studied for all possible variations of the parameters. These choices of parameters has been presented in tabular form in various dimensions. It is seen that irrespective of whatever values of the parameters chosen, the collapse always results in a naked singularity in all dimensions. There is less possibility of formation of a black hole. Hence this work is a significant counterexample of the cosmic censorship hypothesis.Comment: 9 pages, 19 figure

Modern cardioversion strategies for acute atrial fibrillation in a district general hospital

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Spectrum of diffuse parenchymal lung diseases with special reference to idiopathic pulmonary fibrosis and connective tissue disease: An eastern India experience

Objective: To evaluate the clinical spectrum of diffuse parenchymal lung diseases (DPLD) encountered in the Indian setting and to compare idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated DPLD (CTD-DPLD), the two commonest aetiologies. Materials and Methods: A prospective study of clinical, imaging and laboratory parameters of patients diagnosed as DPLD and followed up in the Pulmonary Medicine Department of a tertiary-care teaching institution in eastern India was conducted over a period of one year. Results: 92 patients of DPLD were diagnosed in the study period with IPF (n = 35, 38.04%), CTD-DPLD (n = 29, 31.5%), hypersensitivity pneumonitis (n = 10, 10.9%), sarcoidosis (n = 5, 5.4%) and silicosis (n = 5, 5.4%) being the common causes. The CTD-DPLD group had a lower mean age (39.5 ± 1.86 vs 56.9 ± 1.12 years), a longer duration of symptoms (3.5 ± 0.27 vs 2.5 ± 0.26 years), more extra pulmonary manifestations, significantly more base line FVC and 6-minute-walk-distance than the IPF patients. 19 patients of IPF (54%) opted for treatment. All the IPF patients had a significant fall in FVC after six months (mean change -0.203 ± 0.01 litres) compared to the CTD-DPLD group (mean change - 0.05 ± 0.04 litres.) Conclusion: CTD-DPLD patients belong to a younger age group, with longer duration of symptoms, more extrapulmonary features, better physiological parameters and better response to therapy than IPF patients. Larger prospective epidemiological studies and enrolment in clinical trials are necessary for better understanding of the spectrum of diffuse parenchymal lung disorders and their therapeutic options

Common Presentation with Uncommon Diagnosis: Multifocal Epithelioid Hemangioendothelioma

A young female patient presenting with recurrent hemoptysis, neck swelling, and mediastinal mass mimicking lymphadenopathy was admitted to the Institute of Post Graduate Medical Education and Research and SSKM hospital, Kolkata, India. Clinical features, radiological studies, fibre optic bronchoscopy, and fine needle aspiration cytology from the neck swelling created a diagnostic dilemma until surgical resection and immunohistochemistry reports confirmed the diagnosis of multifocal epithelioid hemangioendothelioma, a rare vascular tumor with intermediate malignancy potential. Because it is a slow-progressing disease and due to the non-availability of standard chemotherapy, the patient, and her legal guardian, opted for palliative care only. She was asymptomatic for four years but again presented with hemoptysis, reappearance of the neck swelling on the same side, and a mediastinal mass compressing the superior vena cava and right pulmonary artery. This report describes the diagnostic problems and therapeutic challenges in the management of this rare tumor over a four-year follow-up period. The clinical course emphasizes the highly unpredictable nature of this tumor

Effect of magnesium infusion on thoracic epidural analgesia

Introduction: Patients of lung volume reduction surgery (LVRS) having an ASA status III or more are likely to be further downgraded by surgery to critical levels of pulmonary function. Aim: To compare the efficacy of thoracic epidural block with (0.125%) bupivacaine, fentanyl combination and (0.125%) bupivacaine, fentanyl combination with adjunctive intravenous magnesium infusion for the relief of postoperative pain in patients undergoing LVRS. Methods: Patients were operated under general anesthesia. Thirty minutes before the anticipated completion of skin closure in both groups, (Group A and Group B) 7 ml of (0.125%) bupivacaine calculated as 1.5 ml/thoracic segment space for achieving analgesia in dermatomes of T4, T5, T6, T7, and T8 segments, along with fentanyl 50 ΅g (0.5 ml), was administered through the catheter, activating the epidural block, and the time was noted. Thereafter, in patients of Group A, magnesium sulfate injection 30 mg/kg i.v. bolus was followed by infusion of magnesium sulfate at 10 mg/kg/hr and continued up to 24 hours. Group B was treated as control. Results and Analysis: A significant increase in the mean and maximum duration of analgesia in Group A in comparison with Group B (P<0.05) was observed. Total epidural dose of fentanyl and bupivacaine required in Group A was significantly lower in comparison with Group B in 24 hours. Discussion: Requirement of total doses of local anesthetics along with opioids could be minimized by magnesium infusion; therefore, the further downgradation of patients of LVRS may be prevented. Conclusion: Intravenous magnesium can prolong opioid-induced analgesia while minimizing nausea, pruritus, and somnolence

Prevalence and risk factors of asthma and allergy-related diseases among adolescents (PERFORMANCE) study: rationale and methods

Despite a considerable number of international reports on allergic diseases among children, information about the prevalence and risk factors of asthma and allergy-related diseases among Indian adolescents is relatively sparse. The Prevalence and Risk Factors of Asthma and Allergy-Related Diseases among Adolescents (PERFORMANCE) study has been conceived to study the aetiology of asthma and allergic diseases including rhinoconjunctivitis, atopic eczema and food allergies among adolescents in West Bengal, India, using standardised methods and collaborations. The aims of the study are: 1) to estimate the prevalence and risk factors of asthma and allergic diseases among the adolescents residing in rural, suburban and urban areas of West Bengal; 2) to obtain information about the possible role of lifestyle factors (smoking, diet and physical activity) on the disease prevalence; and 3) to create a network for further investigation on social, environmental and genetic factors affecting the diseases. The PERFORMANCE study comprises two phases. The phase I study will investigate the prevalence and possible contributing factors of asthma and allergic diseases in a defined population. The phase II study will be performed as a follow-up of phase I to assess the incidence of asthma and allergic diseases